Removing the Stigma from Substance Use Disorder. Joan Duwve, MD, MPH Associate Dean for Practice Richard M. Fairbanks School of Public Health

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1 Removing the Stigma from Substance Use Disorder Joan Duwve, MD, MPH Associate Dean for Practice Richard M. Fairbanks School of Public Health

2 Learning Objectives Recognize the impact of Stigma on getting people into treatment for SUD. Recognize the importance of using non-stigmatizing language for substance use and people with SUD.

3 Summary: How the words we use can support people on the path to recovery Substance use disorder is a chronic brain disease from which people can and do recover. Persistent stigma still creates barriers to treatment and recovery. The White House ONDCP prepared a document which draws attention to terminology related to substance use that may cause confusion or perpetuate stigma. Executive Branch agencies are encouraged to consider the importance of language in their communications related to substance use. Boticelli,Michael. Changing the Language of Addiction.

4 Background Substance Use Substance use (and misuse) impose a devastating health and emotional burden on individuals, families, communities, States, Tribes, and the Nation million Americans 12 or older have alcohol or other drug use disorders million people aged 12 or older report past-month illicit drug use. 64,000 Americans died from drug overdoses in 2016: 175 people every day, 1 person every 8 minutes. 9 out of 10 individuals in need of treatment for a substance use disorder do not receive treatment.

5 Misuse * Substance misuse - use of any substance in a manner, situation, amount or frequency that can cause harm to the person with SUD or to those around them. For some substances or individuals, any use would constitute misuse (e.g., under-age drinking, any use of illegal drugs). Prescription drug misuse refers to the use of a drug in any way a doctor did not direct an individual to use it. * Taken from Facing Addiction in America: The Surgeon General s Report on Alcohol, Drugs, and Health. (2016). Glossary p.3-4. U.S. Department of Health and Human Services.

6 Background the Brain Substance use disorder is a chronic brain disease from which people can and do recover. Addictive substances can lead to dramatic changes in brain function and reduce a person s ability to control his or her substance use.

7 Stigma Dehumanization of the individual based on their social identity or participation in a negative or an undesirable social category. Ervin Goffman, Stigma: Notes on the Management of a Spoiled Identity. 1963

8 Four Identified Types of Stigma Public Endorsement by the public of negative attitudes against a specific stigmatized group, which manifests in discrimination towards individuals belonging to that group. Perceived Stigmatized individuals think that most people believe common negative stereotypes about individuals belonging to the same stigmatized category. Enacted Direct experience of discrimination and rejection from members of the larger society. Self Negative thoughts, feelings, and diminished self-image resulting from identification with the stigmatized group and anticipation of rejection from the larger society. Ervin Goffman, Stigma: Notes on the Management of a Spoiled Identity. 1963

9 Background Stigma People with substance use disorders are viewed more negatively than people with physical or psychiatric disabilities. The terminology often used can suggest that substance use disorders are the result of a personal failing/choice. The term abuse is highly associated with negative judgments and punishment. Even trained clinicians are likely to assign blame when someone is called a substance abuser rather than a person with a substance use disorder. Negative attitudes among health professionals have been found to adversely affect quality of care and subsequent treatment outcomes.

10 Scott County Focus Group I love them (Syringe Exchange Staff) to death. They re nice people. They don t look down on you, because we re just drug users. A lot of people think you re trash because you re an IV drug user [but] they don t. It s the best thing. I am happy about it. (Tracy, F2)

11 Background- Language American Society of Addiction Medicine and others have recommended the adoption of clinical, non-stigmatizing language for substance use. Person-first language has been widely adopted by professional associations to replace negative terms that have been used to label people with other health conditions and disabilities. Person with a mental health condition or person with a disability carry neutral rather than negative connotations, and distinguish the person from his/her diagnosis.

12 Substance Use Disorder The current Diagnostic and Statistical Manual of Mental Disorders replaced older categories of substance abuse and dependence with a single classification of substance use disorder. Terms such as drug habit inaccurately imply that a person is choosing to use substances or can choose to stop.

13 Person with a Substance Use Disorder Person-first language is the accepted standard for discussing people with disabilities and/or chronic medical conditions. Use of the terms abuse and abuser negatively affects perceptions and judgments about people with substance use disorders. Terms such as addict and alcoholic can have similar effects. Using the terms addicted babies or NAS babies stigmatizes both the baby and the mom.

14 Person in Recovery Various terms are used colloquially to label the people with SUD, including the terms clean and dirty. Instead of clean, negative (for a toxicology screen) not currently using substances (for a person) Instead of dirty, the term positive (for a toxicology screen) currently using substances (for a person) The term person in recovery refers to an individual who is stopping or at least reducing substance use to a safer level, and reflects a process of change.

15 Medication-Assisted Treatment Terms replacement and substitution have been used to imply that medications merely substitute one drug or one addiction for another. This is a misconception. The dosage of medication used in treatment for opioid use disorder does not result in a high, rather it helps to reduce opioid cravings and withdrawal. Medication-assisted treatment (MAT) is used to refer to the use of any medication approved to treat substance use disorders combined with psychosocial support services.

16 UNDERSTANDING OPIOID USE DISORDER Outreach Presentation

17 How Do Opioids Work? Opioids work by: 1) Binding to brain receptors 2) Minimizing the perception of pain 3) Stimulating reward centers in the brain 4) Triggering feelings of pleasure, relaxation and euphoria #KnowTheOFacts

18 #KnowTheOFacts

19 #KnowTheOFacts

20 What is the Most Effective Treatment Option? Medication-Assisted Treatment (MAT) Combines prescribed medication and behavioral therapies to treat opioid use disorder #KnowTheOFacts

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22 What can you do to reduce the stigma? #KnowTheOFacts

23 Language matters SAY THIS Person with Opioid Use Disorder Disease Person living in recovery Person arrested for a drug violation Substance dependent NOT THIS Addict, user, druggie, junkie, abuser Drug habit Ex-addict Drug offender Hooked #KnowTheOFacts

24 Language matters SAY THIS Medication is a treatment tool Had a setback Maintained recovery; substance-free NOT THIS Medication is a crutch Relapsed Stayed clean Sources: Office of National Drug Control Policy, Changing the Language of Addiction., 01/09/17. National Council for Behavioral Health, Language Matters, September #KnowTheOFacts

25 In Review Know the O facts Opioid Use Disorder is a Disease There is Treatment Recovery is Possible Be aware of your attitudes and behavior Choose your words carefully Avoid Hurtful labels Be kind to everyone #KnowTheOFacts

26 In Review Educate others Be supportive, include everyone Replace negative attitudes with evidence-based facts Offer compassionate support Treat people with Opioid Use Disorder with dignity and respect #KnowTheOFacts

27 UNDERSTANDING OPIOID USE DISORDER